displacement activity by the prime minister. is he aware of the definition of displacement activity, believed to be a means by which animals relieve tension resulting from 2 contradicting instincts. and also involves actions such as scratching, excessive grooming or chasing one's own tail. will the prime minister agree that we should focus on the economy but if he wants constitutional reform, some of support my can win it -- my 10 minute rule bill, about bills leaving this house, and suspend the right of the government to guillotine debate so long as it is forcing this house to 6 fewer days than it used to in the past? >> i cannot really understand the statements coming from the conservative backbenchs. we must face up to the issue. he seems to suggest that we do

not need to face up to that issue. we do. that is not displacement activity, that is essential activity to restore the reputation of politics. i happen to agree with him about the economy, but the action we have taken is to move the economy as quickly as possible through the downturn but the leader of the opposition fails to ask any questions about the economy any time we meet. >> i welcome the prime minister's statement on constitutional renewal and urge him to ignore the protestations from members opposite. can we end the anachronism of constitutional convention which is too often used as shorthand for doing nothing or resisting necessary change? and secondly, let's go a little further and end the scandal of m ps moonlighting to line their own pockets. we are paid a full-time salary for a full-time job and we should honor that.

>> on july 1st, all of the incomes in the greatest detail to be published, by all members to have second jobs and seconding comes and i'm glad the house agreed and was satisfied that was the right thing to do and the public can judge for themselves what is happening in that area. as far as the convention is concerned, the whole debate about a written constitution, things that are seen as conventional should be made into statutes so people are clear about people's rights and responsibilities. >> you have been watching the british house of commons, it airs and on every wednesday while parliament is in session. you can see this session at eastern and specific on c-span3. .. rosenberg takes you

inside the revolution, how they are battling the to dominate the middle east and transform the world and what's next for the economy, steven moore, peter tannis and former reagan economic policy arthur laffer on taxes and the end of prosperity. foreclosure nation,

>> every weekend is filled with books and authors on book tv. look for our entire schedule online at booktv.org. >> now a discussion on healthcare and efforts to compare the effectiveness of various treatments and medical procedures. speakers include senate finance committee chairman max baucus and white house budget director peter orszag. from the brookings institution, this is about an hour. [inaudible conversations] >> good morning, everyone. i'd like to welcome you here to the brookings institution this morning. i'm mark mcclellan here at brookings and on behalf of bob rubin and the hamilton project we'd like to welcome you to today's event on one of the key issues for healthcare reform. implementing comparative effectiveness research.

we're delighted to have such distinguished participants to discuss this issue today and that, of course, includes all of you here, all of you in the overflow room and i know we've got a lot of participants online as well. comparative effectiveness research has vaulted to the front lines of the healthcare debate as you'll hear from some of your upcoming speakers it could be a game changer a key part of bending the healthcare cost curve and comparative effectiveness research is moving forward. the american recovery investment center the economic stimulus legislation invested $1.1 billion in federal initiatives to conduct, comparative effectiveness and research and expand current activities. this includes an effort to coordinate new and existing efforts in comparative effectiveness research. the legislation created a new federal coordinating council which has begun its work. the institute of medicine will produce its recommendations under the law for national priorities for national comparative effectiveness research effort by the end of this month. but fulfilling the promise of

comparative effectiveness research for better quality, better outcomes in value and healthcare will require answering some important questions that have not yet been tackled. there are some differences and views about whether comparative effectiveness research can have an substantial impact on the healthcare growth curve and there's some further concerns about whether that happening is a good thing. whether such restrictions on cost growth would be a good thing. as we'll talk about today, what kind of impact can come from comparative effectiveness research may come down not just to whether we spend the money but how it's done. such questions include what research issues should be prioritized? what methods are appropriate for comparative effectiveness research and where will the data come from? and how can comparative research wouldings be used to maximize the impact on criminal and health policy decisions. we're going to talk about potential answers to these questions this morning with the help of an impressive and diverse set of participants. we're delighted to be joined by

senator max baucus and peter orszag on how comparative effectiveness and how it can help shape the healthcare system in years to come. then we've got three commission papers and discussants for these peoples these are peer-reviewed papers who have distinguished records and whose bios are listed but we look forward to hearing from you about the best ideas and concerns for moving this healthcare reform debate forward. we've got a full agenda. a limited amount of time. we're not going to have any scheduled breaks. if you need one, please feel free to take it particularly during the brief transitions between the panels. this is a large group. we're going to set this meeting up in a way, though, that has some time for questions and open discussion. we'll have roaming microphones in the audience. please raise your hand if you have a comment. but it's imperative that you keep your questions brief and also please identify yourself when you ask a question.

the event is being webcasted live and we also have a number of press in attendance so please be aware that all the remarks are on the record and finally i want to alert our speakers, not you, senator baucus but our other speakers there's a timekeeper in the front row who will be making sure you stay right on time. [laughter] >> so with that, i'm very pleased to introduce senate max baucus who will be giving the day's opening keynote. senator baucus as all of you know have a distinguished record from service of montana and the country in the senate since 1978. he's chairman of the very important senate finance committee where he's leading an effort with ranking member senator chuck grassley to get consensus on a comprehensive bipartisan healthcare reform bill in the coming weeks. as part of that effort senator baucus has been a passionate advocate for comparative effectiveness research done right sponsoring his own legislation with senator conrad during the last congressional session and including provisions

to address appropriate cost on comparative research. and he finds time for ultra mare thanes which is pretty good preparation for what he's trying to do right now. we're glad to have you back at brookings for this keynote. [applause] >> thank you, mark, very much. and thank you very much for inviting me to your session today to talk about an issue i think of great transitive effect which is comparative research. cynthia nelms once said if men liked shopping, they'd call it research. [laughter] >> think about it. from cars to television when americans go shopping they are readily able to find and evaluate information about the quality and effectiveness of almost anything. but not so for healthcare.

why shouldn't americans have information on what works and what doesn't? when it comes to their health. that question is especially important when one considers that healthcare is where americans spend 1 in every 6 dollars that we spend in a year. since the finance committee began preparing for comprehensive health reform last year, comparative effectiveness research has been mentioned very often. it's almost constantly mentioned and it has raised almost as much controversy. it's a hot topic so much so senators on my committee on both sides of the aisle suggested we stop using the name. stop calling it comparative effectiveness research. so when we talked about this one day i off the top of my head said let's call it fred. that might be more palatable and

less on him news. we can called it patient center effective inss in and it would reflect the intent of the research or we could just call it shopping. whatever we call it one thing is certain, we need to address the very real concerns that this research -- very real concerns that this research might be used to, quote, ration healthcare. people talk about comparative effectiveness versus clinical effectiveness. people talk about whether the research can be used to make coverage decisions. these concerns boil down to one underlying issue, rationing. this is serious and it needs to be addressed with integrity. there's several ways. the first is to make sure that the research is patient-focused. the research must consider patient's preferences for how they want treatments to work. patients must be actively involved in setting the research priorities and designing the research studies. the research findings need to be

relevant for patients. we should assist patients so we can participate the process in developing priorities and designing studies. patient representatives should have been given training on technical matters so they can interact with researchers and other stakeholders on these matters. in short, patients must be at the center of medical center that we want answered next, practicing physicians need to be at the table. not just researching physicians but those who use prescribed medical care. they know what questions to ask and they are key to making the research meaningful for the decisions that would be made with patients. third, we need safeguards. safeguards when it comes to the use of research in federal healthcare programs. medicare and medicaid should not be allowed to create automatic links to any single study. these programs need to be open, transparent, and thorough in how

they use patient centered research. nothing should be done behind closed doors without public input. we should not build walls around the research. we should not bar any federal program from using it in responsible and transparentive way. many patient groups see the value, indeed, the need for this type of research. let's take prostate cancer. men with prostate cancer have a choice among three common treatments. surgery, radiation and chemotherapy. each approach yields different outcomes in terms of survival and quality of life. some areas of the country tend to use one approach. some use other approaches. and some of these are more costly and less effective than the others. comparative effectiveness research would compare the clinical outcomes of each

approach in a systemic way. that way doctors and patients would have more information by how options work and for whom. patients want to know what the best options are and this type of research would help. so what is the future of patient-centered outcomes research? we have two choices. we could continue to hope that each year congress passes scarce dollars and the ones they produce are ones of national import or we could put this research on more solid ground moving from political influence and funding cliffs by setting the ground rules by how it's identified and conducted. i prefer the second approach. and that is why i introduced comparative act research in 2008 as mark said along with my colleague kent conrad. he and i share a passion for this. we believe it is fundamental to transforming our health system from one that is volume-driven to one that is evidence-based.

there are many, many other components of moving that direction but comparative effectiveness research is clearly a part of it. this year we plan to reintroduce the bill. we've been discussing it constantly with staffs and the committee and elsewhere. we're close to coming to an agreement and that's important because i intend to include my bill that is the comparative effectiveness bill in a comprehensive health reform bill that we'll mark up in the finance committee later this month. and that brings me to my last point. the need for comprehensive health reform. the finance committee has spent many hours, many days, weeks, months laying the groundwork. you have 12 hearings last year all day summit at the library of congress we held three round table discussions outlining options for reform. totally inclusive, totally bipartisan. i've never participated in a

more inclusive endeavor in my life. we can to one funnel agreement that something must be done. in 2008 america spent 2.4 trillion in healthcare. that's one-sixth of our economy. yet we ranked last in major industrial nations on the health systems performance which ranks the number of deaths that could be prevented before age 75 through effective healthcare. last, the united states ranked last. some analysts estimate that as much as 30% of our spending is for ineffective redundant or inappropriate care. that's care that does nothing to improve the health of americans. our system leaves nearly 50 million americans without health insurance, 25 million more with inadequate coverage and most bankruptciess in america are related to medical costs. our system needs reform. if we fail to act, healthcare spending will account for 20% of our economy in 10 years. put it another way, 45% of a

family's budget will be spent for healthcare premiums. raising -- rising healthcare costs will swap federal and state budgets, businesses and american families alike. if we continue to spend at this rate it's only fair that we ask ourselves, what are we getting for our money and what are we not getting for it? it's time for americans and their doctors to use the world's most advanced science so that the most personal healthcare decisions can be made with access to the best available information. okay. i'll admit it. the experience of going to a doctor will not not be quite as much fun as shopping for a car. but let's make it -- make sure because we spend one out of every $6 in america let's to make it's the most efficient as we buy that car and that tv and that way not only will we get a better experience when we go to the doctor, we also can get healthier americans. thank you very much. [applause]

>> thanks very much, senator. and senator baucus has graciously agreed to stay for a few questions so if you could raise your hand, as i said we'll have roving microphones around the room. so hands up if any -- if any questions. yes, up here in front, allen. the mic is coming. great. >> hello, thank you. ellen seigel friends of cancer research. first i want to thank you for all your work on comparative effectiveness. it's been really appreciated. question, a senate bill on the funding had clinical effectiveness. it was taken out of the house side. perhaps you can address that or address the importance of clinical effectiveness and some of the nuances? >> yeah. the real issue here, and it was

a big battle, frankly, in the stimulus bill is it rationing or is it not rationing in political terms. and that came down to the cost benefit analysis will not be included in a clinical effectiveness research. and some members of the congress especially in the senate also in the house were fearful that would be used to ration the cost benefit analysis. and i made it very clear, no, this is clinical effectiveness. clinically does this procedure, does this drug, you know, medical device -- is it better than the other or not? i'm fond of explaining how fda now refs a drug application looks only to see whether it's safe and did it work. and it compares it with a

placebo and not against another drug. we need to do a comparison not just drugs but medical procedures and we have much more evidence-based medicine in america and based more on value and reimbursement is based more on quality than volume. and i think that we'll be able to get this included in healthcare reform as comparative effectiveness research, fred, we want to call it -- as long as we make it clear that there's no cost benefit analysis here. this is pure clinical comparison. >> senator, just to follow up on that. there's some people who have argued if you don't have a focus on cost as well, then it's going to make it more difficult to use comparative effectiveness research against savings. it sounds like from your presentation earlier with all the evidence on ineffective care or the wrote this care you cited that you don't agree?

>> i think cost will come in and decisions made by patients, by providers will take cost into consideration 'cause they will know one procedure cost compare to the other. patients will know too, insurance companies will know. and -- but that's a decision that they're all going to have to make when they have the clinical comparison. it's up to them to look up to the close but it's not up to the agency themselves to prescribe for to decide what to use to decide. >> thank you. lindsey from bloomberg news. >> i don't know if your microphone is on. >> can you hear me? >> yeah. >> okay. we know that senate republicans sent the letter to president obama, i think, just yesterday voicing their concern about a government-run healthcare plan. i want to know how you plan to bridge that divide? i know there are a lot of meetings going on this week

about that. and what you feel about this opposition? i know you're very close to senator grassley? >> i think it would take very long before i got that question. [laughter] >> you know, it's interesting to me, i'm very, very pleased like, for example, this morning front page both the "new york times" and the "washington post" articles about the need to transform our healthcare system. and that reflects the view of senators. both sides of the aisle. we know and not to be presumptuous about this but republicans know and deeply know that we need to transform our healthcare system. the quote by senator gregg this morning is good evidence of that, is a good example and we're trying mightily to find a resolution. it requires a lot of education. one of my biggest problems in getting -- in getting healthcare

legislation passed it's so complex. it's so difficult. we have a fairly steep learning curve four us and for some of us it's nearly vertical. [laughter] >> we have spent a lot of time and that's why we had all these sessions, all these meetings, getting people up-to-date, up to speed. and how does this work? what works? what's good? and, you know, ignorance breeds fear. and so the more we dig into it, we had a lot of meetings on so-called public option. we meet daily, i do with other senators, particularly, key senators, especially, senators on the republican side who i think -- who i know are trying to find a solution here to see how we, you know, thread that needle. but it's -- that letter is just to be honest about it, it's an indication -- it's somewhat -- i don't want to overstate this because somebody will jam this down my throat but somewhat positioning in getting ready for the resolution that we come up with but we'll find a

resolution. >> time for one more question in the back there. >> gary, national minority quality reform. in 202040% of the u.s. population is going to be african-american. >> i'm sorry, i can't see you. sorry. >> in 2020, 40% of the u.s. population is going to be african-american or hispanic. when you look at clinical trials last point 6% of the clinical trials african-american, about 3% hispanic. how do you do comparative effectiveness in that environment? and even more importantly, how do we prepare the healthcare system for a diverse population with patient variability? >> well, clearly, the comparison analysis has to take that into consideration and make it an affirmative effort to make sure that the trials are representative of the whole population as a whole. you know, i am very excited. we are on the eve of doing something terrific here in

america. healthcare reform. it's going to be so transformative. it's going to be game-changing and a lot of it is in the delivery reform. i see peter orzag is here. it's true. i'm very heartened too. i'm so happy someone gave me this article to read. man, this is a great article. and it turned out the president read it, too, about the same time and independently came to the same conclusion. and i got to tell you it's the rage among senators, it's the june 1 issue. is he here. >> we'll hear about it in just a minute. >> it's not perfect. nothing is perfect but man oh, man we're moving in the right direction. and i'm very confident because of the basic understanding of the good will of the members of the house and senate that we're going to get healthcare reform passed this year. it's going to take work because it's complicated. it's really complicated. people don't understand it. we're also going to have to

educate the american people. you know, that's what we work for. they are our employers. they are our bosses and that's going to take a lot of work, too. i remember talking to bill navelli formerly head of aarp. his membership just doesn't quite understand all what's going on here and we've got to take that bit of information to heart here as we work to make sure the american people understand what it's about as well. thanks, everybody. glad you're doing this. it's so important. thanks for your effort. >> senator, thanks so much. [applause] >> thanks senator baucus. now it's a real honor for me to introduces my cochair for this event, robert rubin. bob joined the clinton administration in 1993 serving as assistant to the president for economic policy and the first director of the national economic council. he also served as our nation's

70th from 1995 and 1999 where he played a leading role in the nation's most important policy debates and also was my boss back then. general from 1999 to 2005 he served in a number of roles including co-chairman of foreign relations and serving on mt. sinai, harvard and other medical groups as well. he's one of the founders of the hamilton project, the economic policy project that's housed here in brookings and he continues to offer innovative policy proposals in how to benefit a growing economy. bob? [applause] >> thank you, mark. as mark said i'm bob rubin. i'm here on behalf of the hamilton project and i join with mark in welcoming all of you with what i agree with max baucus' comment that this is a very important subject and a

very useful event. we're deeply honored to have as our speaker, our first speaker, max baucus. he's an old friend. i spent many, many months fishing the waters of montana. i have set a state record for leaving flies in the trees along the rivers of that wonderful street. [laughter] >> we're also deeply honored to have with us peter orszag, the director of the office of management budget and i'll introduce peter shortly. let me first step back for a moment from today's discussion. and agree with something that senator baucus said. i've been around economic issues in various regards for a long, long time. and i don't think there is any question that it's absolutely imperative that we have major reform of our healthcare system. to address wasteful expenditures, to reduce the rate of increase of healthcare costs, to improve outcomes and absolutely critically, to move toward accomplishing universal coverage.

the rapid rate of increase in our nation's healthcare costs is in my view a grave threat to our economic future, both by undermining competitiveness and by fueling the steep rise in federal healthcare expenditures which is i'm sure peter will tell you is at the heart of an unsustainable long-term fiscal position in our country. i am certainly not an expert on healthcare reform. and as max said, senator baucus said, it's a very complex subject but many, many such experts believe the comparative effectiveness research the subject of our discussion today, has the potential over the longer term to materially reduce the rate of increase of healthcare costs and at the same time to improve outcomes. the papers that will be discussed by the outstanding group of